Why “Take A Deep Breath” is the worst advice you can give an anxious person
It was not until I trained in the Buteyko method that I understood why, and why the solution is the exact opposite of what most people are told.
What actually happens when you "take a deep breath"
When someone is anxious or panicking, their breathing is already disrupted. It tends to be fast, shallow, and centred in the upper chest rather than the diaphragm. The sympathetic nervous system (fight or flight) is running the show. The standard advice assumes that taking a big, deep breath will counteract this by flooding the body with oxygen. The problem is that oxygen is not what your body is short on.
A clinical psychologist writing in Psychology Today explains that during hyperventilation, there is already too much oxygen in your system relative to the amount of carbon dioxide, and that taking a big gulp of air extends and exacerbates the hyperventilation cycle [1]. You are not calming down. You are doubling down on the exact breathing pattern that is causing the symptoms.This is not fringe science. Johns Hopkins Medicine states directly that the goal when treating hyperventilation is to raise the carbon dioxide level in the blood, and that to increase CO2, you need to take in less oxygen [2]. That is why the old paper bag trick works. It recirculates CO2.So when someone tells you to take a deep breath during a panic attack, they are, with the best of intentions, telling you to do more of the thing that is making you panic.
The Bohr effect: the bit nobody explains.
Here is where it gets interesting, and where most breathwork content on the internet falls short.There is a well-established principle in respiratory physiology called the Bohr effect, first described in 1904 by Danish physiologist Christian Bohr [3]. It describes how haemoglobin, the protein in your red blood cells that carries oxygen, adjusts its grip on oxygen based on the levels of carbon dioxide and pH in your blood.In simple terms: when CO2 levels are adequate, haemoglobin releases oxygen to your tissues efficiently.
When CO2 drops too low, as it does during hyperventilation or big deep breathing, haemoglobin holds onto its oxygen more tightly. Your blood is technically saturated with oxygen. But your cells, including your brain cells, are not getting as much of it delivered. This is not a theory. It is textbook physiology. The StatPearls medical resource, published by the National Library of Medicine, confirms that the Bohr effect describes haemoglobin's lower affinity for oxygen release when CO2 is reduced and blood pH increases [4].
A decrease in CO2 provokes an increase in pH, which results in haemoglobin picking up more oxygen and releasing less of it to tissues [3].Read that again. More breathing can mean less oxygen where it counts.This is the paradox that most "just breathe" advice completely ignores. The person gasping for air during a panic attack feels like they cannot get enough oxygen. But the sensation of air hunger is driven by CO2 sensitivity, not by an actual lack of oxygen. Published research on panic disorder confirms that clinical and experimental studies have linked reductions in CO2 levels (hypocapnia) to emotional states including overwhelming stress and panic, and that a wide range of patients with anxiety disorders have been found to have low CO2 values [5]. Their oxygen saturation is almost certainly fine. Their CO2 is depleted. And every big breath depletes it further.
Why this hits differently if you have ADHD
This is where I stop talking in the abstract and start talking about what I see in my own life and in clients.I want to be very clear about something before I go any further: mouth breathing does not cause ADHD. ADHD is a neurodevelopmental condition with strong genetic and neurological roots. It is not a breathing problem, and no amount of nasal breathing is going to rewire the dopaminergic pathways that make ADHD what it is. Anyone telling you otherwise is selling something.
What is true, and what the research does support, is that there is a significant overlap between ADHD and dysfunctional breathing patterns. People with ADHD are more likely to be chronic mouth breathers. There is a direct relationship between breathing dysfunction and these neuropsychiatric presentations: children with ADHD tend to have a higher incidence of allergic rhinitis and nasal congestion, and 40% of children who suffer from sleep disorders including sleep apnoea and snoring develop ADHD, ADD, or a learning disability [6]. A 2021 cross-sectional study (Kalaskar et al.) of 100 children who were mouth breathers found 73% showed inattention at school and 66% had difficulty waiting their turn [6].The Bohr effect provides a plausible mechanism for why dysfunctional breathing can make existing ADHD symptoms worse, not cause them, but amplify them. Chronic overbreathing, whether through the mouth or through habitual fast chest breathing, keeps CO2 levels low. Low CO2 means reduced oxygen delivery to the brain. A 1999 paper published in the Journal of Applied Physiology showed that hyperventilation caused asynchronous firing among cortical neurons, impairing concentration [7]. Reduced oxygen delivery means neurons become more excitable, which can layer additional fog, restlessness, and impulsivity on top of what ADHD is already doing.Dr Buteyko himself observed that overbreathing decreases oxygen supply to the brain, increases the excitability of nerve cells, and destabilises mental focus [8]. Whether or not you accept every claim from the Buteyko tradition (and I would encourage healthy scepticism, as I do with any single framework), the underlying physiology of the Bohr effect and CO2-mediated cerebral blood flow is well established [3][4].
Here is the practical implication:
If you have ADHD and someone tells you to take a deep breath, you may be making things harder for yourself. Not because you are doing it wrong. Because the instruction itself is wrong for your physiology. Buteyko will not cure your ADHD. But it might stop your breathing from making it louder.
What Buteyko does differently:
The Buteyko method flips the standard advice on its head. Instead of breathing more, you learn to breathe less.That sounds counterintuitive, and honestly, it felt counterintuitive the first time I tried it. The method involves gentle nasal breathing with a deliberately light, quiet, barely perceptible breath. No big inhales. No dramatic exhales. No forcing. The goal is to gradually increase your body's tolerance to carbon dioxide through reduced breathing volume and controlled breath holds [9].The key measurement in Buteyko is the Control Pause (sometimes called the BOLT score): the number of seconds you can comfortably hold your breath after a normal exhale before feeling the first urge to breathe. It is not a competition. You are not holding until you go blue. You are measuring how quickly your body panics at a small rise in CO2 [10].A Control Pause under 20 seconds is often associated with asthma, rhinitis, anxiety, panic disorders, and sleep-related breathing issues [10]. Above 25 seconds indicates functional breathing with an 89% chance of good respiratory health [10]. Above 40 is excellent.Most people who come to me for breathwork sessions score between 10 and 18 seconds on their first measurement. That is not a failure. That is information. It tells us exactly where to start and gives us something concrete to track over time. Each 5-second improvement tends to come with a noticeable reduction in symptoms [10].
Why this works for people who have given up on breathwork:
Here is what I think makes Buteyko different from most breathwork modalities, and why it lands particularly well with neurodivergent clients.First, it does not ask you to go inward in a way that feels unsafe. There is no eyes-closed, "observe your inner landscape" instruction that leaves you trapped with your own spiralling thoughts. You are breathing through your nose, lightly, and paying attention to the sensation of air at your nostrils. It is external, tangible, and specific. For someone with ADHD whose brain treats silence like a vacuum that needs filling with catastrophic thoughts, that specificity is everything.Second, it does not rely on big dramatic breaths that can trigger hyperventilation. The entire philosophy is less air, not more. For someone who has tried box breathing during a panic attack and felt worse, this is a fundamentally different experience.Third, it gives you a number. The Control Pause is objective, trackable, and responds to practice. For an ADHD brain that thrives on concrete feedback and visible progress, that is not a small thing.And fourth, there is growing evidence that the mechanism works. A 2016 study (Patricio Mario et al.) found that a four-week Buteyko programme increased CO2 tolerance by 50% and significantly reduced resting heart rate [7]. Slow, controlled breathing techniques have been shown to increase heart rate variability (a marker of vagal tone and parasympathetic function) and reduce stress markers [11]. The Institute for Functional Medicine notes that extending, slowing, and holding respiration are all considered vagal manoeuvres that stimulate the vagus nerve [12], which is your body's primary brake pedal for the stress response.
The case against Buteyko (and why you should hear it)
If I am going to recommend this method, I owe you the counter-argument. And the counter-argument is not trivial. The Buteyko method is not widely accepted in mainstream medicine. A thorough analysis published on Science-Based Medicine reviewed all available Buteyko studies on PubMed and found that of the three studies designed to test Buteyko's proposed mechanisms of action, none supported his theories [13]. The five studies comparing Buteyko to a control for asthma treatment showed some reduction in medication use, but no change in participants' actual lung function. The author's conclusion was blunt: the evidence suggests Buteyko may alter a patient's perception of their symptoms and prevent overuse of medication, but does very little to change the underlying condition [13].The Australian Government's Department of Health reached a similar conclusion in 2015, reviewing Buteyko as one of 17 alternative therapies and finding no clear evidence of effectiveness for any of them [14]. A 2020 Cochrane review found that breathing exercises may have some positive impact on quality of life and hyperventilation symptoms, but rated the evidence as moderate to very low certainty [15].A peer-reviewed paper in Applied Physiology, Nutrition, and Metabolism (2023) went further, specifically warning that some Buteyko advocates associate the technique with loosely related research to imply benefits that have not been demonstrated [16]. The paper explicitly called out the practice of citing studies on allergic rhinitis in children with ADHD to imply that Buteyko's nasal breathing focus can reduce ADHD risk, describing this as a claim currently lacking plausibility and evidence [16]. That is a fair criticism, and I take it seriously. I have tried to be careful in this article not to make that leap. What I have said is that dysfunctional breathing can worsen symptoms in someone who already has ADHD, not that fixing breathing will fix ADHD. Those are very different claims.There are also legitimate concerns about Buteyko's origins. The method was developed in the Soviet Union in the 1950s by a single physician based on a personal revelation, not a controlled experiment [9]. The original theoretical framework, that hyperventilation is the root cause of over 150 diseases, is an extraordinary claim that has never come close to being substantiated [14]. Some of the more enthusiastic corners of the Buteyko community still promote claims about curing conditions ranging from diabetes to epilepsy [14], which is frankly irresponsible.And there is a standardisation problem. Buteyko is not a single, codified protocol. Different practitioners teach it differently, which makes it extremely difficult to study rigorously [17].
When a clinical trial tests "Buteyko," it is not always clear exactly what intervention was delivered, which muddies the evidence base further [17].
So why do I still use it?
Because I think there is a meaningful distinction between Buteyko's original theoretical framework (which is shaky) and the practical techniques themselves (which overlap substantially with evidence-based respiratory physiotherapy). Nasal breathing, reduced breathing volume, diaphragmatic engagement, and extended exhales are not Buteyko-exclusive ideas. They are components of breathing retraining that appear across mainstream respiratory medicine, yoga, and clinical psychology [16].The Bohr effect is real, documented physiology [3][4]. The relationship between CO2, cerebral blood flow, and neural excitability is well established. The fact that hyperventilation depletes CO2 and produces anxiety symptoms is confirmed by Johns Hopkins [2], the Cleveland Clinic [18], and published research on panic disorder [5]. The idea that slow, reduced breathing stimulates vagal tone is supported by clinical research published in Psychiatric Times [11] and by the Polyvagal Institute [19]. None of that is Buteyko-specific. What Buteyko provides is a structured, accessible framework for applying those principles, particularly the Control Pause as a feedback tool.I do not teach Buteyko as a cure for anything. I teach it as a practical breathing retraining method that, in my experience and the experience of my clients, helps with nervous system regulation, stress tolerance, and the specific frustration of finding that conventional breathwork advice makes things worse.
It is not a replacement for ADHD medication, therapy, or any other form of professional support. If you have ADHD, keep working with your GP or specialist. If you are on medication that works for you, keep taking it. Breathing better is a complement to those things, not a substitute.You deserve to know both sides before you decide whether it is worth trying. I think it is. But I would rather you make that decision with your eyes open than have me gloss over the gaps.
Where to startIf you are curious
Start by measuring your Control Pause first thing tomorrow morning. Sit upright, breathe normally through your nose for a minute or two, then after a gentle exhale, pinch your nose and time how long before you feel the first definite urge to breathe. Not how long you can endure. The first urge. Write it down.Then breathe through your nose for the rest of the day, as much as you can. That is it. That is step one. No apps, no equipment, no commitment beyond paying attention to whether your mouth is open.
If you want to go further, I run breathwork sessions through Low Tide Calm, both in person in Wicklow and online for clients throughout the world. The programme is built specifically for people who find conventional breathwork inaccessible, with a particular focus on neurodivergent adults and people dealing with chronic stress or burnout.
You do not need to be good at breathing. Nobody is good at breathing when they start. That is the whole point.
Cian O'Driscoll is a breathwork and mindfulness facilitator, reflexologist, and complementary therapist based in Wicklow, Ireland. He works with neurodivergent adults and burned-out, stressed humans through Low Tide Calm.
To book a session or find out more, visit lowtidecalm.ie.
References:
[1] Psychology Today (2021). When "Take a Deep Breath" Can Be Bad Advice. psychologytoday.com
[2] Johns Hopkins Medicine. Hyperventilation. hopkinsmedicine.org
[3] Bohr effect. Wikipedia, sourcing Bohr, C., Hasselbalch, K., & Krogh, A. (1904). wikipedia.org/wiki/Bohr_effect
[4] Benner, A. et al. (2023). Physiology, Bohr Effect. StatPearls, National Library of Medicine. ncbi.nlm.nih.gov/books/NBK526028
[5] Meuret, A.E. et al. (2010). Hyperventilation in Panic Disorder and Asthma: Empirical Evidence and Clinical Strategies. International Journal of Psychophysiology. PMC2937087
[6] Buteyko Clinic International. Children's Breathing Difficulties, citing Kalaskar, R. et al. (2021). Sleep Difficulties and Symptoms of ADHD in Children with Mouth Breathing. buteykoclinic.com/adhd-research
[7] Referenced via IMD Breathwork, citing Patricio Mario et al. (2016) and Journal of Applied Physiology (1999). imdbreathwork.com
[8] Advanced Buteyko Institute. advancedbuteyko.com
[9] Wikipedia. Buteyko method. wikipedia.org/wiki/Buteyko_method
[10] Buteyko Clinic International. How to Test Your Breathing: Guide to Breath Hold and Control Pause. buteykoclinic.com
[11] Gerbarg, P.L. & Brown, R.P. (2016). Neurobiology and Neurophysiology of Breath Practices in Psychiatric Care. Psychiatric Times. psychiatrictimes.com
[12] Institute for Functional Medicine. Understanding PTSD From a Polyvagal Perspective. ifm.org
[13] Albietz, J. (2011). Buteyko Breathing Technique: Nothing to Hyperventilate About. Science-Based Medicine. sciencebasedmedicine.org
[14] Australian Government Department of Health (2015). Review of the Australian Government Rebate on Natural Therapies for Private Health Insurance. Referenced via Wikipedia: Buteyko method [9].
[15] Santino, T.A. et al. (2020). Breathing exercises for adults with asthma. Cochrane Database of Systematic Reviews. Referenced via Wikipedia: Buteyko method [9].
[16] Cooke, J. et al. (2023). Distinguishing science from pseudoscience in commercial respiratory interventions. Applied Physiology, Nutrition, and Metabolism. PMC10013266
[17] Bruton, A. & Thomas, M. (2005). The Buteyko breathing technique for asthma: A review. Complementary Therapies in Medicine. ScienceDirect
[18] Cleveland Clinic. Hyperventilation Syndrome: Symptoms, Causes & Treatment. my.clevelandclinic.org
[19] Polyvagal Institute. What is Polyvagal Theory? polyvagalinstitute.org